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The North Dakota Experience: Achieving High-Performance Health Care Through Rural Innovation and Cooperation |
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From The Commonwealth Fund: North Dakota faces health care challenges common to many rural areas of the U.S., but the state's health care system appears to be performing better than that in many other states--rural or urban. Resource constraints and the desire to preserve the local economy have made necessity the mother of invention in North Dakota, driving health care providers and policymakers to try new approaches to care and to institute better practices relatively quickly. Collaboration to support primary care and the concept of a medical home, organization of care through cooperative networks of providers, and innovative use of technology to meet patient needs and hold down costs are examples of how North Dakota is able to provide its citizens with accessible, quality, and efficient health care despite the challenges of a rural setting. Rural communities have a unique context of community trust and interdependence, a social capital that allows them to innovate in meeting patients' needs. North Dakota faces challenges common to other rural areas of the country that are relatively disadvantaged in attracting health care professionals and in deploying resources to serve small, geographically dispersed communities. Despite these challenges, the state's health care system appears to be performing better than many others in providing its citizens with accessible, relatively high-quality, and efficient health care services, as evidenced by the findings of two recent reports. North Dakota ranks in the top quartile of states on The Commonwealth Fund's State Scorecard on Health System Performance, which ranks states according to their performance across 32 key indicators of access, quality, utilization, equity, and health outcomes (Exhibit 1 and Appendix A). The latest Dartmouth Atlas of Health Care finds that North Dakota is one of the most efficient states in treating chronically ill Medicare patients in the last two years of life, with costs more than 25 percent below the national average.
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